I am Going to Need an Assistant

Happy Wednesday!

As a follow-up to my last post, my outreach stint in Willmar was a great experience. I was able to treat a wide range of patients and performed a few procedures under faculty direction I had not had a chance to do before.

One of my favorite parts of the clinical experience was working with an assistant. The efficiency of four-handed dentistry was a dramatic change compared to my dental school solo attempts at multi-tasking. I noticed immediately that the assistants were always busy. Whether they were setting up the cubicle, sterilizing instruments or taking inventory of supplies, they kept the office and the patient flow running smoothly. I remember reading an AGD Impact article on suggestions to prevent burnout. The article says that a dentist should spend the majority of their time with patients, so other roles and tasks must be delegated to the rest of the team. I think most of us struggle with control issues and perfectionism, so it can be hard to give up the reins on things. Given the investment we make in our education and in our practice, who can blame us for our urge to micromanage? This emphasizes the importance of hiring the right people for the job who will fit together as a dental “team.”

What traits do you suggest a dental office looks for in an assistant? How do you match an assistant’s personality with the dentist’s? What suggestions do you have for maintaining authority but still being friends with your employees?

Now that I am back at school, I am marking off my to-do list for graduation requirements. I am also preparing myself for my patient-based board exam in March. Today, you can find me in Saint Paul at “Dental Day at the Capitol,” lobbying with classmates and area dentists.

With only 79 days left until graduation, I am starting to see the light at the end of the tunnel!

Katie Divine, Minnesota ’13

Caring for the Teeth Dearest to our Hearts

When our daughter’s first two teeth came in, I was so excited that I brought my work camera home to take close-up pictures. Our children’s teeth have a special place in our hearts. Caring for them can be challenging, yet exciting and even quite full of fun.

When I used to see a child with plaque and cavities, I would address the parents. I would wonder about the obstacles that could be limiting this child’s oral care at home. Today, I am better equipped with firsthand experience caring for my own child’s teeth. I understand that it is not easy. I let my patients know that getting children to allow parents to brush their teeth is the real challenge, but the conversation always brings joy to my heart.

We know about wiping babies’ gums with a soft, wet washcloth before their teeth come in. We know that, as the teeth start to appear, we should be using a baby toothbrush with a tiny amount of fluoride toothpaste twice a day. In addition to these usual recommendations, I share advice based on my personal experience:

- Learn how to say “Ahh” in many melodies, such as “Twinkle Twinkle Little Star.”

- Babies love having their teeth brushed. But as they become toddlers, they want to do it on their own. Do not fall into that trap; they really cannot brush their own teeth.

- They like the taste of toothpaste more than the act of brushing.After sucking on the toothbrush for a while, they will hand you the brush if you are around or you will be looking for it in every corner of your house. Make sure that you have a spare toothbrush ready, because you may need it the next day.

- They also like floss when it is flavored. However, they should not be left alone because they can swallow it. If they already talk, they are very honest about it and will tell you that they swallowed it.

- Positive reinforcement works much better than warnings. Try, “Brush your teeth tonight so we can go to gymnastics class tomorrow.” It may work better than telling them that we cannot go to gymnastics class tomorrow if they don’t brush their teeth. With warnings, you may always get a negative response. You can try different methods of positive reinforcement. Technology incentives, such as playing on smartphone, may not a good idea before bedtime. Our daughter likes pennies and likes to put them in her piggy bank. She calls them lucky coins;s he hears that on the Mickey Mouse TV show. For $3.65 a year, you can get a toddler to brush at night; I think that is a great deal!

- Another approach is to hand them your toothbrush so that you brush their teeth as they brush yours. Stay back though; they can easily push the toothbrush far inside your mouth.

Now our daughter is two-and-a-half years old, which means that soon we will have to look for new ideas. How do you get preschoolers and older children to brush and floss?

Samer Alassaad, DDS

A (Slightly Delayed) Introduction

Hello blog readers and fellow AGD enthusiasts. I am honored to have been asked to contribute to this blog. What a wonderful avenue to mentor and be mentored by my colleagues. The only problem is that this should be my second post. Yes, I am THE Chris Perry who missed his first post of the year on January 7. Fortunately, the AGD has been understanding and allowed me to try to make up for my shortcoming. Please excuse me for being a space cadet. I was in the middle of moving my office and just totally forgot.

The positive side is that I have spent the last year preparing for and completing this new facility and am looking forward to sharing some of my experiences from the last year. I hope to offer some useful suggestions for the good, the bad, and the unnecessarily expensive costs of building a new office. This was my second office build and you’d think I would have learned a few things the first time around. But leave it to me to make a few of the same mistakes and a whole crop of new ones. Just as in dentistry, you learn more from your mistakes than from your successes.

Allow me to give you a bit of my background and let you know who Christopher Perry, DMD, MS, FAGD (MAGD in June!), really is. After graduating from the University of Medicine and Dentistry of New Jersey in 1999, my wife, Maritere, and I moved to San Antonio, Texas. While this was quite a culture shock to a native Jersey boy, it was the best move we could have made. I was able to complete a two-year AEGD residency at the University of Texas Health Science Center in San Antonio Dental School and have maintained a close relationship with the school for the last 14 years, while in private practice.

Residency was the best thing I ever did for my career because it allowed me to be a sponge. I could work alongside amazing dentists without the pressure of tests and earning a diploma. Residency totally changed the type of dentistry and practice that I now enjoy. I couldn’t imagine that I would be able to put an IV in a patient to sedate them, perform any type of dentistry while they relax; from fillings to thirds, CEREC, and implants, and have them thank me and pay me well for it. In case you haven’t noticed, I strongly recommend that students pursue an advanced residency program; it is like one to two years of hands-on CE that you simply can’t get in any other format.

I am so passionate about educating dentists that I have volunteered weekly as a clinical professor in the AEGD program for 12 years. It is such a pleasure to meet dental graduates from schools all around the country. I have really gained insight into what the modern dental curriculum does well and where it falls short (you will see over time that I feel that occlusion is woefully misunderstood and underappreciated in dentistry today).

I also am co-director of the FellowTrack program at the UTHSCSA Dental School, which is a program that gets dental students involved with the AGD and allows members to earn up to 50 CE credit hours before even graduating from dental school through lunch and learn programs. It is such a pleasure to work with the undergraduate students and see their enthusiasm for dentistry and their interest in advocacy issues.

In case you haven’t noticed, I love teaching and learning. One of the great things about dentistry is that, as my own boss, I can decide when I want to take or teach a course. I have been fortunate enough to be asked to speak on topics such as practice management, occlusion, and implants. I have spoken at the ADA Annual Session, the California Dental Association, and the Star of the South Dental Meeting. I am honored to be on the list of speakers for the AGD 2013 Annual Meeting & Exhibits in Nashville.

My goal as a blogger for The Daily Grind is to share as much as folks are willing to hear. I always tell my students and residents that I am an open book and no question is out of line. I plan to share some of the aforementioned lessons from building two offices and offer practical, useful practice management tips from my courses. I will also share consulting and clinical suggestions that I have learned from 14 years of practice and supervising 100s of residents. Please, please, please, leave some comments suggesting topics about which you are interested in hearing and having an open discussion. My wife, daughter, Isabella, and dentistry are my passions, but teaching and learning feed my soul.

Thank you again for inviting me to contribute to this wonderful program. Until my next post, keep your eyes open to the possibilities.

Christopher J. Perry MS, DMD, FAGD

The Perks of Being a Recent Graduate

Greetings from NYC!

First of all, I want to say that I am excited to contribute to this blog and sincerely appreciate all of your feedback and support. Although my time spent in private practice has been limited since I graduated from dental school in 2010, I hope to offer a unique and relevant perspective.

When I attend a CE course in this city, the speaker often mentions their area of practice (complete with photos of local attractions), commenting that they love it so much and how overwhelming it must be to work in a place like this. New York can feel that way sometimes. Living here, you forget to notice the crowds of people on the subway and sidewalks, the trash on the street, and the general sense of urgency that flows through the air. New Yorkers are neurotic, overbearing, and impatient. Fortunately, I am a native, so it takes a lot to intimidate me. Most days, I love it. Other days, I day dream about moving to the country, having a huge house and opening up my own practice in a place where there aren’t entire skyscraper floors devoted solely to dental offices.

In dentistry, as in any other professional field, you will have some great days. You will also have awful ones. While many of us like our jobs, there are many who hate it, too. In my limited time out here in the workforce, I have been fortunate enough to find a great job in my favorite city; I don’t have much to complain about. Blogs like these can be a great outlet to rant about the little nuances of our jobs, but they can better serve to shed a positive light on our profession. As a newly minted dentist, my most inspiring moments have been attending educational conferences where I meet and learn from great dentists who absolutely love what they do. If you are right out of school and are hesitating spending the money on attending a conference, it was well worth it for me. Many organizations offer large discounts for recent graduates. It will motivate you to become a better dentist.

I am almost 30 years old, and I am finally starting to feel like an adult. Dental school and residency are behind me, and I have just celebrated my first-ever job anniversary. I realize I am a little old for this, but unlike my college friends that have been working since they were 22, I have only recently begun to maintain a steady income. Weekends do not involve full day study sessions in the library and weeknights can be filled with watching way too many medical TV dramas, guilt-free. When I get invited to a party or a destination wedding, I no longer dread checking my calendar to make sure it is not around a hectic exam period. A word of encouragement to all dental students out there: there is a light at the end of the tunnel. Private practice is tough, but in my humble opinion, dental school is a lot worse.

There are many perks of being a young dentist right now. One is understanding the power and importance of the internet, particularly social media. In our industry, technology is constantly evolving and we have to be able to evolve with it. I find that this is the number one advantage someone like me may have when comparing myself to a dentist that has logged many more clinical years. One of the downsides - and a big frustration of mine - is the lack of experience. Nothing can replace those hours of patient care that older doctors have under their belts. All these fellowships and credentials seem so far out of reach at this point. But I am trying to set realistic goals and be patient. Even with the amount of continuing education that is available, from hands-on lectures to podcasts and videos, it cannot replace the years of real life experience you gain from being in private practice for a decade or more. Maybe I won’t have all the answers when I am older, but I am looking forward to not being questioned about my age and experience by new patients.

Until next time, friends! I will be posting about various topics once every six weeks or so. If you are interested in connecting with me on a more regular basis, you can follow me on Twitter @LilyaDDS. If you do not already have an account, I highly recommend it. Then you can follow the AGD, too. The AGD has two Twitter handles. Follow @AGDadvocacy for the latest on local and national advocacy issues affecting you, and follow @AGDevents for the latest information on upcoming AGD events.

Cheers,

Lilya Horowitz, DDS

Love is in the Air

With Valentine’s Day upon us, love is in the air. Many say it is a commercial holiday, invented by folks at the greeting card companies. I say let’s use it as a reminder to appreciate the simple things in life. The time can be thought of as a mini-Thanksgiving, without the turkey dinner calories. This spirit can encompass the people in our lives, the luxuries we may have, and the hobbies we enjoy.

Many of us don’t “love” the pressure to buy flowers for that special someone or make those oh-so-hard-to-get dinner reservations at the best restaurant in town. But we can embrace the ability to attempt such endeavors. As dentists, most of us can provide a little extra for our loved ones. And for those of us who don’t hold anyone near or dear, we probably have a fancy gadget or toy that brightens up our day. It sounds shallow, but most likely true.

Most of all, we should love what we do. Dentistry can be challenging and frustrating, but the rewards are plenty. Whatever it is that you “like” about this profession, do yourself a favor, and “love” it for the day. And save the cavity-causing candies for someone else…

Jason Petkevis, DMD

No More Manic Mondays

My name is Andy Alas. Like you, I am a frequent visitor to this blog. I practice in beautiful Southern California. You may have read my blog comments under the name Dr. Andy. I accepted the challenge of submitting a blog and this is the result.

Now let’s get down to the business of dentistry. I am frequently asked to explain the best ideas that I have incorporated into my practice. These are the changes that have resulted in real practice success. One major strategy that has reaped benefits is to take Mondays off. Spend Mondays with your family or visiting friends.

Why do we take Mondays off? So we can work all day Friday and STILL have a 3-day weekend. Why work Friday? Quite simply, it is the most productive day of the week. Notice that I did not say work half a day on Friday. I mean you work a full day on Friday.

Why are Fridays so successful for our practice? It’s easy: you are closed and we are open. Try the following experiment. Call around your town and try to find a dentist in his/her office on Friday at 3 p.m. Then, call those same offices on Monday morning. You’ll notice that EVERYONE is in their office. You can imagine who turns the emergency patients seen on Fridays into regular patients. Additionally, a lot of your patients have Fridays off. Whether they work a 4-day week or their job requires them to be at work on weekends (restaurateurs, real estate agents, etc.), they are off on Friday. They don’t want to take time off from work during the rest of the week. This way, they don’t have to. You are suddenly available for “weekend” appointments without having to be there on Saturday!

Right now you are probably thinking that your patients need you there on Monday because they may have an emergency over the weekend. Really? Do you REALLY have so many emergencies over the weekend that you have to be there on Monday from 8 a.m. until 5 p.m.? Most dentists average one or two weekend calls per month. Besides, for most emergencies, you can call in a prescription.

“But my patients want me available all week.” They already assume you have Wednesday afternoons off for golf and that you are closed on Fridays. We just inform our patients that Monday is “Daddy Day” with my 3-year-old daughter. I really do spend Mondays with her and no crown prep is more important than that.

“But all the really cool continuing education courses begin on Friday.” Really? Every Friday has a must-attend CE course? Even though I work every Friday, if a super interesting and important course comes up, I will attend. That adds up to one or two a year.

One final reason that general dentists don’t consider is that patients want major treatment done on Friday. This gives them the chance to recover over the weekend and not miss work during the rest of the week. Oral surgeons are very familiar with this thinking and most accommodate these patients.

If you wish to do yourself a favor, start working on Friday. You will find that it is the easiest day for your front office to schedule. Your practice will be more productive because of it. But don’t give up after working only one Friday. Patients need to learn about your new schedule.

Let me know what you think.

Andy Alas, DDS

A Clinical Instructor's Humble Perspective

Happy Friday! Are you in a TGIF frame of mind this week? I often have mixed feelings about getting swept up in the “Thank Goodness It’s Friday” mindset. While I do love my weekends, I truly love my practice as well. I almost feel guilty that I don’t always set my sights on the weekend. It wasn’t always that way though.

To be perfectly frank, the strong love that I have for my business didn’t come right away. Dentistry was actually my second career. I was a registered nurse for 10 years before I decided that I wanted to join my dad in his well-established dental practice. I had two very young children when I made this decision. I don’t have to tell any of you just how much of a challenge it was to go to dental school and be the mom that I wanted to be for my kids at the same time. To say my life was stressful is a bit of an understatement.

When I graduated, I naively thought that I’d hop right in alongside my dad and the patients would be lining up outside the door waiting to see me. Okay, I wasn’t THAT naïve. But, despite my dad’s generosity, his patients wanted to see him. They did not want to see the daughter they had heard of but had no relationship with. I realized that I had to earn my stripes and their respect. It was not an easy road. I had loans to pay, mouths to feed, and a mortgage. I started supplementing my income by working as a visiting nurse on my off days and as the dentist for a local nursing home. Gradually, my patient base grew to the point that I was able to slowly wean myself from my other jobs.

Over the past 23 years, my business has grown and evolved. I’ve learned many, many valuable lessons about owning a business. These lessons have translated into career satisfaction, a successful business and a desire to teach others what I have learned. I teach at the academic level as a clinical instructor at Marquette University School of Dentistry and at the business level as Social Media DDS.

I am really excited to be part of a truly amazing group of bloggers at the AGD’s The Daily Grind! I love reading of our colleagues’ adventures in the world of dentistry and how our chosen career impacts our daily lives. I look forward to sharing with you my take on the business of dentistry and what I do to always keep it interesting.

Teaching, at some level, has always been a passion for me and an integral part of my professional life. I enjoy teaching patients, teaching dental students, and even teaching dental offices best marketing strategies. I want to share some of my observations of the dental students that are going to be our dental colleagues in a few years.

I have been a clinical instructor for almost five years now. I have to tell you that I am absolutely ecstatic about the quality of today’s dental students and the passion for dentistry that they exude. It is a sincere pleasure to work with these students. I am touched by their enthusiasm and their respect not only for their patients but for their clinical instructors as well. I am moved by their seemingly unquenchable thirst for knowledge and sincere desire to listen to any and all tips that the clinical instructors share.

I am thrilled to keep in touch with many of the students (now dentists) after graduation and watch how they evolve into a fine representation of the dental industry and an honorable representation of Marquette’s dental school. I realize that I am slightly biased in my love of Marquette. I am completely aware that there are many wonderful dental schools out there (including my own alma mater, University of Illinois College of Dentistry). These schools produce phenomenal students and have exceptional faculty guiding them in their daily endeavors.

If there are any colleagues out there who have thought about teaching at their alma mater or the nearest dental school, please do give it serious consideration. I can’t think of a more rewarding experience than to watch students as they move from year to year with increased knowledge and confidence and an ever-growing commitment to the dental industry. It is inspirational to me. I found myself going back to work after teaching each day and wanting to do better. My patients deserve the very best and so do my students. The students deserve to know that I am willing to walk the walk and teaching has helped to keep me honest and humble.

If you are a faculty member at a dental school, I would love to hear your thoughts and experiences in the comments section below. I would also love to hear the thoughts and experiences of any dental students going through the rigors of dental school. I love seeing brand new dentists like Dr. Diana Nguyen and dental students like Katie Devine and Dave Coviak contributing alongside the seasoned dentists here on The Daily Grind!

Here’s to a great experience for writers and readers alike!

Claudia Anderson, DDS

Five Things They Didn't Teach You in Dental School

You don’t know what you don’t know. I wish someone had told me that they call it “commencement” for a reason. Here I was, walking across the stage, donning that famed lavender cap and gown, thinking it was all finally coming to an end. Four years of blood, sweat and tears were finally at a head, and four-day work weeks with voluptuous paychecks were right around the corner. I had given up my twenties for the hum of fluorescent lights in the quiet nooks of the area’s most desolate libraries. But my thirties? My thirties were going to be good.

Ha.

My first two years in private practice consisted of long, spotty workdays, five to six days a week. Accessing pulp chambers with a quivering hand, one eye closed, and a “Hail Mary” under my breath wasn’t an uncommon occurrence. Exiting the room to grab “another instrument” to buy myself just enough time to run a radiograph by my boss was the norm. Feeling my heart racing under the self-inflicted pressure of thinking I was taking far too long for the patient’s comfort to perfect my crown margins was standard. Sleepless nights and elevated blood pressure readings were more common during the first two years out of school than they had been while I was still in school. Hmph.

The first two years were hard. Really hard. Now in my third year out, I’m in a routine, feeling confident and doing some great dentistry. Here are five things they didn’t teach me in dental school that I wish they had. They might have saved me some of those sleepless nights my first years out.

1. Family, friends, and family friends can be some of the most difficult patients you will ever treat. While it is initially tempting to build a practice off of people you already know, it’s a slippery slope. It is difficult to be objective. I always feel extra guilt that there are standard fees and copays associated with their treatment. While I enjoy treating some family and friends, there are others that I’ve learned are better served by the dentist I work for.

2. Look and act the part. Your chairside appearance and demeanor will gain your patient’s trust far more easily than your excellent hand skills will. The dentist I work for wanted me to try wearing scrubs to work. For the two months I tried, patients either questioned my age or asked when the doctor would be in. A quick transition to business-casual, a white lab coat and a set of heels, and the patients open without hesitation for me to work away. Professionalism isn’t something they spend much time on in dental school, but patients can sniff it out from a mile away.

3. Contrary to popular belief, you will not be buying a yacht your first year out of dental school. But your patients think you will. The only voluptuous paychecks I had anything to do with were the ones I sent to the banks in the form of student loans each month. At the end of each day, I’d reflect back on how hard I had worked, how much I had sacrificed to be where I was. I would question what I had done. My first paycheck (for a two week pay period) was for $213.16, BEFORE taxes.

As scary and frustrating as it is to watch the bills roll in each month when your pay seems nominal, be patient. I’ve learned that it takes time to improve your hand skills, improve your patient rapport, and become generally more efficient. Worry about the treatment you provide and the money will come on its own. Your patients think you are buying a yacht with their crown copay. You have to have confidence in the quality and service you are providing for your patients, because many of them won’t understand the education, training, lab fees and overhead associated with the care you provide. In their minds, that $1,000 check is directly deposited into your personal account.

Don’t let patients discredit your work. Don’t allow finances to sway the treatment options you provide for a patient. It is your responsibility to give patients all of the options and it is their responsibility to decide which option best fits their overall situation.

4. Dentists are your friends. Never put another dentist’s work down. When a patient comes to you complaining of a previous dentist, don’t indulge in their disdain. Unless you were in that dentist’s shoes at the time of treatment, you don’t know the entire situation. Offer condolence that the patient had a displeasing or unsatisfactory experience and move on. Let your own work speak for itself.

5. Unless your friends and family members are in the dental field, they will look at you like you are speaking a foreign language when you tell them that dentistry is stressful. Don’t you get paid well to work a few hours and golf the rest of the week? What’s stressful about that? This career can break you down. The rewards are immense, but not without normal, everyday bumps in the road. Treatment decisions are difficult and patient management can be nearly impossible. Lean on your fellow dentists to work through the normal stresses of the career. If I didn’t have colleagues to vent to and lean on, I don’t think I would have made it through those first two years.

Courtney Lavigne, DMD

Communicating with Patients

I have been in private practice for just seven months. While I’ve learned countless tips for diagnosing and treating teeth, the more valuable lesson I’ve learned is the power of good communication with patients. This really hit home for me last week when I met and examined a new patient.

My new patient was no stranger to the dental chair, as he had a mouth full of crowns and amalgams. He was having a particular issue with a lower molar, so I sat him up, showed him x-rays, explained to him what was wrong, and gave him options for the treatment of the tooth. As he left the room that day, he looked me in the eye and said “Thank you so much. This is the first time a dentist has ever explained anything to me.”

I was shocked! I assumed that a patient with so many crowns would have at least been given a basic explanation for why the crowns were needed. It only took five minutes of my time, but I gained the trust and confidence of the patient.

I tend to give patients a very simple explanation of their dental health and treatment needs, but then leave the option for a more detailed description. Some patients want to know every detail, while others would rather not talk about teeth! I have had great success with some simple questions. “Did I explain that well? Is there anything else I can show or tell you to help you understand the situation?”

At the treatment visit, I often begin with a question that I learned from my senior dentist (who just so happens to be my father): “Good to see you this morning! What are we doing today?” When the patient answers with the correct treatment, my father typically responds with “Great. I am glad we are on the same page.” These questions are helpful because they require the patient to take ownership of the treatment. It confirms that the patient understands the need for treatment.

What communication tips have worked well for you? Do you have any advice to give some of us newer dentists? Leave a comment below with any pointers you have with regards to explaining findings and treatments to your patient.

Elizabeth Cranford, DMD